TRICARE HPSA Bonus Payments

Many providers are unaware that they may be entitled to bonus payments of 10% when providing services to TRICARE beneficiaries.  The process for determining eligibility is not simple, but the possible upside of eligibility is significant.

Providers that are eligible to participate in the bonus program include podiatrists, physicians, oral surgeons, and optometrists.  In order for eligible providers to quality for these additional payments, the provider needs to be rendering the underlying health care service in a geographically approved health professional shortage are.  If an eligible provider is located within a qualifying area, the provider then needs to take the additional step of appending the appropriate modifier to the claims for which the additional payments are being requested.

Providers are, as a general rule, not allowed to apply for these payments retroactively, and therefore it is imperative that claims are appropriately billed at the time of initial submission.  A wrinkle may arise if the provider is contracted with one of TRICARE’s managed care support contractors.  In these situations, providers should review applicable contract terms, as well as applicable policies and procedures, to determine if the provider can seek retroactive corrections of claims billed which omitted the applicable modifier.